Undercover investigators score PPACA subsidies
Originally posted July 23, 2014 by Kathryn Mayer on www.benefitspro.com.
Undercover investigators using fake identities were able to get health insurance and tax subsidies through the federal exchange under the Patient Protection and Affordable Care Act, underscoring ongoing problems and security issues plaguing the health care law, officials said Wednesday.
The nonpartisan Government Accountability Office said they created 12 identities with fake citizenship and immigration statuses and phony income documents to test how easy (or difficult) it would be to get coverage and subsidies under the law.
The agency said 11 of the fake applicants were accepted, and the HHS-run exchanges rejected just one applicant because it lacked a Social Security number.
Though HealthCare.gov flagged some attempts as problematic, the fake applicants found more success on phone calls to call centers handling applications.
“For its 11 approved applications, GAO was directed to submit supporting documents, such as proof of income or citizenship; but, GAO found the document submission and review process to be inconsistent among these applications,” the agency said. “As of July 2014, GAO had received notification that portions of the fake documentation sent for two enrollees had been verified.”
Republicans jumped on the latest news, saying it was yet one more flaw in the faulty law.
“Ironically, the GAO has found Obamacare is working really well — for those who don’t exist,” said Senate Finance Committee Ranking Member Orrin Hatch, R-Utah.
The Obama administration said it was taking the report seriously and would work to strengthen the law’s verification process.
The GAO remarked that findings were “preliminary” and they weren’t jumping to any conclusions yet. The agency said it would release a more detailed report in the coming months.
Eight million people signed up for health plans using the exchanges under PPACA.
The GAO report follows PPACA’s latest hurdle: two conflicting court rulings out Tuesday regarding the legality of PPACA subsidies issued to enrollees in the federal exchange.
Appeals court nixes subsidies for HHS exchange users
Originally posted July 22, 2014 by Allison Bell on https://www.lifehealthpro.com
A three-judge panel at the D.C. Circuit Court of Appeals has issued a decision that could block efforts to expand access to private health coverage in states that decline to set up state-based insurance exchanges.
The judges ruled 2-1 in Jacqueline Halbig et al. vs. Sylvia Mathews Burwell et al. (Case Number 14-5018) that the Internal Revenue Service (IRS) has no authority under the Patient Protection and Affordable Care Act (PPACA) to provide premium tax credit subsidies for users of the PPACA public exchanges run by the U.S. Department of Health and Human Services (HHS).
The subsidies have helped cut the amount QHP buyers pay out-of-pocket for premiums to an average of less than $50 per month.
PPACA created a premium tax credit subsidy for people who buy qualified health plan (QHP) coverage through the exchanges by adding Section 36B to the Internal Revenue Code (IRC).
PPACA lets HHS set up public exchanges in states that decline to set up their own exchanges. IRC Section 36B talks about providing credits to users of state-based exchanges and makes no mention of any credits to be provided for people who buy QHP coverage through the HHS-run exchanges, Circuit Judge Thomas Griffith writes in an opinion for the majority.
"The fact is that the legislative record provides little indication one way or the other of congressional intent, but the statutory text does," Griffith writes. "Section 36B plainly makes subsidies available only on exchanges established by states. And in the absence of any contrary indications, that text is conclusive evidence of Congress’s intent."
Griffith notes that Congress explicitly imposed some key PPACA commercial health insurance provisions, such as guaranteed issue and community rating requirements, on federal territories without providing full exchange subsidy funding for the territories.
PPACA implements some health insurance requirements, such as the community rating requirements, by making changes to the federal Public Health Services Act. HHS last week decided that, because the territories are not going to receive full PPACA expansion funding, the Public Health Services Act excludes territories from its definition of "state," and the PPACA insurance requirements seem to be destabilizing the territories' health insurance markets, the territories can be exempt from the PPACA rules that were set by changing the Public Health Services Act.
How Obamacare’s Progress Makes Expanding Coverage Harder
Originally posted July 21, 2014 by Drew Altman on https://blogs.wsj.com.
The Affordable Care Act’s success meeting its initial enrollment goals and the repair of HealthCare.gov seem to have calmed the political waters for Obamacare. But the job of enrolling the uninsured gets harder, not easier, because the remaining uninsured will generally be tougher to reach.
Recent surveys show, roughly in line with expectations, that 8 million to 9.5 million fewer adults are uninsured compared with last year before the Affordable Care Act went into effect. Specific data are not yet available for uninsured children who probably got covered as well, and an earlier provision of the health-care law that allowed people to stay on their parents’ insurance up to age 26 is thought to have lowered the number of uninsured young adults by as many as 3 million.
But tens of millions of Americans are not yet covered.
Those who enrolled last year during the first open-enrollment season were more likely to want coverage and were best able to navigate the process to get it. After open enrollment this fall and the one after that, the uninsured will gradually become a smaller and different group. Increasingly, they will be people who have been without insurance for a long time or who have never had it; people who are even less familiar with insurance choices and components such as premiums and deductibles, as well as unfamiliar with the tax credits offered under the ACA. These people are more likely to be men, and minorities, and have limited education or language barriers. Increasingly they will fall into harder-to-reach high-risk groups, such as the homeless, who require very targeted outreach, and Hispanics who fear that seeking coverage could endanger undocumented relatives despite assurances from government that it will not.
On the plus side for the next open-enrollment season, many of the remaining uninsured waited out the first year but want insurance; a group of unknown size has been waiting to enroll this fall. Also, the penalties for not having insurance rise from the greater of $95 per adult or 1% of income this year to $325 or 2% of income next year. That is likely to motivate more of the remaining uninsured to enroll. Early studies show that the uninsured who have attained coverage are happy with what they got, and news will spread through family, friends and word of mouth to people who are uninsured, motivating some of them to seek coverage too.
As the job of reaching the uninsured gets tougher, the need will grow for targeted community-based outreach and enrollment services and, most of all, a realization that the remaining uninsured are a somewhat different group presenting new challenges.
5 Reasons to Make Friends with Your Competitors
Originally posted July 21, 2014 by Marla Tabaka on www.inc.com.
When I owned my coffeehouse (2001-2004) people frequently asked me if I hated Starbucks. I didn't. After all, Starbucks is responsible for re-introducing the culture of coffee in the United States and for establishing it in countries where the cafe culture never before existed. Starbucks put the romance into the coffee experience. Without those romantic notions consumers wouldn't have given a second look at my drive-thru, or stop by for a fireside chat over a delicious cuppa joe with their friends. Thank you Starbucks!
Still, the truth is that the coffee giant made it impossible for an independent coffee retailer like me to compete, so I didn't. Instead my business became what Starbucks is not. It too became a household name but for reasons far from its convenience and fast service.
Stop viewing your competition as the enemy and instead use it as the catalyst to brilliance. Instead of investing your precious energy into hating or envying your competitors use it to become the very best entrepreneur you can possibly be. Here's how.
Give your customers another reason to choose your brand.
I knew that my delicious, fair trade coffee wasn't enough to bring customers through the door so I gave more dimension to the consumer experience. I added open mic nights, brought in great bands, and did art shows and book signings. I even opened a private conference room to local businesses and organizations.
What can you offer in addition to your products or services? When you stand out from the competition by offering something of value that your competitors don't, you give your customers a better reason to choose your product or service. How can you help your customers go beyond a simple purchase and truly experience your brand?
Keep the price down to remain competitive.
When I purchased my coffeehouse I knew that I would have to bring down the cost of goods. It forced me to move outside of my comfort zone and negotiate with vendors. In many cases I found new suppliers, and I never stopped negotiating.
Don't get complacent about costs. Just because your suppliers have served you for years doesn't mean they can't do better. Also keep an eye out for new materials, parts, or products that will create a cost savings.
Innovate, innovate, innovate.
What sells today may not sell tomorrow. I've had too many entrepreneurs come to me for coaching because their once successful business became a cash drain.
Watch what your competition is doing to stay ahead and learn from their wins, as well as their failures. Don't get complacent! Don't get so caught up in the day-to-day operations that you neglect coming up with the next great idea. That's the mistake these entrepreneurs made and, sadly, it's often too late to breathe life back into the brand.
Upgrade your skills.
When you allocate all available cash and human energy to your business it's virtually impossible to invest in training and education for yourself. Keeping abreast of the latest technology and trends, and constantly honing your leadership skills will help you gain and maintain the competitive advantage.
Make a list of your weaknesses and make a plan to build upon the skills you need to overcome them. If you cannot acquire those skills yourself, then outsource or hire someone who can provide necessary skills to compete effectively.
Embrace new technology.
As technology improves and evolves the marketplace changes, sometimes drastically and often overnight. You must be ready to adapt or change according to industry trends and business in general, or your competition will leave you in their dust.
Social media is a great example. Believe it or not I still hear from people who don't even have a social media presence and don't believe they need one. Last year I worked briefly with a caterer whose business took a nose-dive over a period of two years. We narrowed down the cause to a lack of online presence. Her closest competition added a customer-facing backend to their website and aggressively engaged in social media. But she simply refused to understand why this would make a difference and sadly, made no attempt to catch up with her competitors. Her doors are now closed.
Embrace competition and your whole world can change. This simple shift in your mindset will keep you engaged, aware, and in the lead.
Do or die: Make a plan and stick to it
Originally posted July 11, 2014 by Sandy Schussel on https://www.lifehealthpro.com. 
My friend and colleague, Steve Chandler, author of Wealth Warrior: The Personal Prosperity Revolution, places professionals into two categories: “Doers” and “Feelers.”
Doers come to work having planned out what needs to be done, and no matter how they’re feeling, they do what needs to be done.
What Feelers do, on the other hand, depends on how they feel at any given moment. They take their emotional temperatures throughout the day, checking in on themselves and figuring out what they feel like doing. Their financial securities, outcomes and lives are dictated by the fluctuation of their feelings. Their feelings will change constantly, of course, so it’s hard for Feelers to follow anything through to a successful conclusion, no matter how passionate they may be.
As Chandler puts it, “The success of Feelers depends on everything that can change their feelings… biorhythms, gastric upset, too strong a cup of coffee, an annoying call from home, a rude waitress at lunch, a cold, or constipation. Those are the dictating forces—the commanders—of a Feeler’s life and of his or her success.”
A Doer, however, has a plan and a system for her success, and she works the plan no matter how she feels. She knows in advance how much time she will spend on the phone and in the field, what new clients she will cultivate and which existing relationships she will strengthen. Regardless of her mood, she looks at any project lacking completion and asks, “What do I need to do?”
A Feeler may have a plan, too, but will only follow it on “sunny” days—when things are going well and she’s in the right mood. She will tell herself she just can’t make those calls right now because she wouldn’t be very effective unless she was feeling good about making them.
As Chandler explains, each of us has a Doer and a Feeler within us. While many of us vacillate between the two types, some may be predisposed to being either a Doer or a Feeler, and over time, some may even unconsciously commit to one type or the other.
If you recognize yourself as a Feeler and you’re not having the success you want, consciously commit to becoming a Doer instead. Set a goal, create a plan to reach it and have a daily system that you follow—no matter which way the wind is blowing.
Sandy Schussel is a speaker, business trainer and coach who helps sales teams develop systems to win clients. He is the author of The High Diving Board and Become a Client Magnet. For more information, go to www.sandyschussel.com.
Benefit package critical for small businesses
Originally posted July 11, 2014 by Alan Goforth on https://www.benefitspro.com.
Small businesses are taking a cautious approach to hiring, compensation and employee benefits, according to the 2014 Aflac WorkForces Report for Small Businesses. The study of businesses with three to 99 employees also found that benefits are a key component to employee hiring, retention and satisfaction.
Although 63 percent of small-business employees are extremely or very satisfied with their job, many believe there is room for improvement when it comes to their benefits packages. Only 12 percent are extremely satisfied with their benefits, while only 14 percent believe their benefits package meets their current family needs extremely well.
These numbers are vital to employers, because 50 percent of small-company employees said they are likely to seek a new job in the next year. Of that number, 57 percent said they probably would accept a job with slightly lower pay but better benefits. On the other side of the coin, 47 percent said improving their benefits packages is one thing their employers could do to keep them in their job.
"Employees at a small business might be satisfied with their pay, enjoy their company environment, their colleagues and the work itself, but that doesn't mean better benefits offerings elsewhere won't entice them to leave," said Teresa White, executive vice president and chief operating officer of Aflac Columbus. "These findings should alert small-business decision-makers that robust benefits, including voluntary insurance, are an important way to keep employees engaged, productive and loyal."
The study found that 85 percent of small-business employees consider voluntary benefits to be part of a comprehensive benefits program. Six in 10 workers at small companies see a growing need for voluntary insurance benefits today, driven by:
- Rising medical costs (71 percent);
- Increasing price of medical coverage (63 percent);
- Increasing deductibles and copays (58 percent); and
- Reduced number of benefits and/or amount of coverage by their employers (29 percent).
Small-business leaders are well aware of employee concerns and the importance of benefits. Although 84 percent said they either maintained or grew sales and revenues in 2013, they are concerned about taking care of employees and continuing their benefits options. This may be one reason why they hired at a slower pace than medium or large companies last year.
Health care employers need cure-all for retirement epidemic
Originally posted Jully 11, 2014 by Michael Giardina on https://ebn.benefitnews.com.
Like other industries, health care employers and benefit plan managers in the health care sector are struggling mightily with their ability to address the retirement preparedness of their evolving workforces.
Whether it’s the remnants of the baby boomers or introduction of millennials, the workforce dynamic in the health care industry is going through a change as the it continues to cope with the ongoing hiccups of the Affordable Care Act. Plan fiduciaries at health worksites also caution the need to motivate their employees to save adequately and helping them learn how to invest wisely.
The health care segment includes more 4,000 defined contribution plans, with approximately 5,200 retirement plan participants. In total assets, the health care sector has more $317.8 billion, which is about 40% of the overall DC not-for-profit market.
Ty Minnich, vice president, not-for-profit institutional markets at Transamerica Retirement Solutions, says the root of the problem is the “pendulum shift” from defined benefit to DC retirement plans, which adds to the retirement confusion.
“The aging population, although affecting all industries, is creating a workforce management issue – particularly in health care, where the demand for younger employees is there,” says Minnich. “The technical expertise, the knowledge they need with the sophistication of the changes in medical delivery [is critical], yet they have employees entering the retirement period of their careers and they are not retiring because they are not ready to retire, from a financial perceptive.”
According to health care retirement plan sponsors, approximately 75% say that employee engagement is one of the most significant challenges in managing a retirement plan. Of the more than 100 hospital administrators and chief financial officers surveyed by Transamerica and the American Hospital Association, most agree that helping employees save for retirement and retaining employees are top goals for their retirement plan.
Another wrench in the operation of health care businesses has been the ACA, and its overnight transformation – according to some in consultancy space – of how business is done in the field.
“[Health care] is undergoing an enormous change, from the perspective on how they get reimbursed for their delivery model,” says Minnich. “What you seeing is that the smaller regional community-type organizations just can’t exist in this marketplace.”
David Zetter, of Zetter Healthcare Management Consultants, explains that he is seeing similar shifts in all aspects of benefits and services – from small practices to large groups and health systems that the health care accounting and consulting firm works with.
“I don’t see how health care practices are going to do it,” explains Zetter, also a board member of the National Society of Certified Healthcare Business Consultants. “It’s just getting so expensive, and reimbursements are going down. It’s tough for a doctor to make ends meet at this point in time and if they keep wanting to be the employer of choice they are going to have to ante up. Unfortunately that’s going to cost them quite a bit of money, especially from a benefits standpoint.”
Meanwhile, there has been a change in how plan sponsors measure plan success in the medical industry. There is more of a focus around retirement readiness rather just solely participation rates, according to the study. And this intensified focus on improving employee interaction and tailoring print and electronic education touch points exemplifies how health care retirement plan sponsors are reacting.
“It all indicates that the plan sponsors are not only realizing they have to do more to help participants get ready for retirement, but also helping participant to help themselves,” says Grace Basile, assistant director of market research at Transamerica Retirement Solutions. “There’s no more ‘set it and forget it,’ there’s no more just getting into the plan.” Instead, she says it’s all about “increasing [engagement] over time, [and] making sure your investments are appropriate for where you are in your age and career.”
Overall, employers and their employees have been riddled with uncertainty of retirement since the recession. However, according to the Employee Benefit Research Institute, retirement confidence reported some meager gains from the losses over the past five years. Approximately 18% of Americans are very confident and 37% are somewhat confident with the future financial needs.
Nevin Adams, co-director of the Employee Benefit Research Institute Center for Research on Retirement Income, adds that all employers – not just those in the health care space – are faced with the challenges of finding the sweet spot of automatic enrollment, default rates and participation.
“One of the things that we are really hearing from employers is that employee benefits are going to continue to be sort of a differentiating factor,” Adams tells EBN. He says that demographic shifts are one of the biggest challenges for employers to deal with.
“The baby boomers [are] kind of hanging around, and the millenials looking for a place to come in,” he notes. “The benefit package and how it’s put together really will make a difference.”
Conflicting Views Of Supreme Court’s Contraception Decision Cloud Other Cases
Originally posted July 8, 2014 by Julie Rovner on https://www.kaiserhealthnews.org.
The Supreme Court’s decision last week that some for-profit corporations don’t have to comply with the contraceptive coverage mandate under the Affordable Care Act may have raised more questions than it answered. Expect confusion – and arguments – as lower court judges and the Supreme Court itself apply the decision to other cases.
This became apparent soon after the Hobby Lobby ruling when the court granted a temporary injunction to Wheaton College, a Christian school in Illinois. The college argued in a lawsuit that the special provisions provided by the Obama administration allowing it to escape the mandate are still insufficient.
But the order for the college, citing the Hobby Lobby ruling earlier in the week, created some confusion over whether Wheaton employees would still get access to contraceptives under the law. And the order provoked a blistering dissent from Justice Sonia Sotomayor, joined by the court’s two other female members, Justices Ruth Bader Ginsburg and Elena Kagan. They argued that the majority was already breaking with the precedent it established only days earlier.
Here are some of the questions raised by the Hobby Lobby case and the remaining cases also challenging the contraceptive coverage mandate.
What is the contraceptive mandate?
As part of the Affordable Care Act, most health insurance plans are required to cover, with no cost-sharing beyond premiums, a wide array of preventive health benefits. For women, that includes all contraceptives approved by the Food and Drug Administration, as well as sterilization procedures and patient education and counseling.
The mandate does not include coverage of RU-486 (mifepristone), the drug used for medical abortions after a pregnancy has been established. But it does require coverage of emergency contraceptives and intrauterine devices, which some believe can prevent the implantation of a fertilized egg. (Newer research suggests that is probably not the case, by the way.)
Who has sued to try to block the mandate?
There have been two separate sets of court cases challenging the contraceptive coverage requirements.
The first set comes from for-profit corporations that, under the law and accompanying federal regulations, are required to provide the benefits as part of their insurance plans. According to the National Women’s Law Center, there have been 50 cases filed by for-profit firms, while the Becket Fund for Religious Justice, which is representing many of those suing, counts 49. Most of those companies charged that the requirement to provide some or all of the contraceptives in question violated their rights under a 1993 federal law, the Religious Freedom Restoration Act (RFRA.)
The cases filed by Hobby Lobby, a nationwide arts-and-crafts chain, and Conestoga Wood Specialties, a Pennsylvania cabinet-making firm, were the first of those to reach the Supreme Court for a full hearing.
Religious nonprofit entities, mostly religious colleges and universities and health facilities, filed the second set of cases. The NWLC counts 59 nonprofit cases; the Becket fund, 51.
The Obama administration, under regulations issued by the Department of Health and Human Services in 2013, is not requiring those organizations to directly “contract, arrange, pay for, or refer” employees to contraceptive coverage. But the organizations say the process by which they can opt out of providing the coverage, which involves filling out a form and sending it to their insurance company or third-party administrator, still violates their religious beliefs by making them “complicit” in providing something they consider sinful.
What did the Supreme Court rule in the Hobby Lobby case?
The majority opinion written by Justice Samuel Alito said that “closely held corporations,” including those like Hobby Lobby and Conestoga Wood Specialties, can exercise religious rights under RFRA. Further, because the Obama administration was requiring those firms to directly provide the coverage, rather than offer them the same accommodation it was offering religious nonprofit groups, the requirement was not “the least restrictive means” of ensuring that women can get contraception and thus a violation of the law.
In making the case for Hobby Lobby and Conestoga Wood, Justice Alito went out of his way to praise the accommodation for religious nonprofits, saying it “does not impinge on the plaintiffs’ religious beliefs that providing insurance coverage for the contraceptives at issue here violates their religion and it still serves HHS’ stated interests.”
What impact has the Hobby Lobby decision had on pending nonprofit cases?
A fairly substantial one. Later that same day the Hobby Lobby decision was handed down, a federal appeals court in Atlanta cited it in issuing an injunction against enforcing the mandate against the Eternal Word Television Network.
But the real fireworks erupted on July 3, when the Supreme Court granted its own injunction in the case filed by Wheaton College.
The unsigned order required the college to write to the Secretary of Health and Human Services, stating “that it is a nonprofit organization that holds itself out as religious and has religious objections to providing coverage for contraceptive services.” The order specifically said the college “need not use the form prescribed by the government, EBSA Form 700, and need not send copies to health insurance issuers or third party administrators.”
Justices Sotomayor, Ginsburg, and Kagan were furious.
“Those who are bound by our decisions usually believe they can take us at our word. Not so today,” Sotomayor wrote. “After expressly relying on the availability of the religious nonprofit accommodation to hold that that the contraceptive coverage requirement violates RFRA as applies to closely-held for-profit corporations, the court now, as the dissent in Hobby Lobby feared it might…retreats from that position.”
What happens now?
The court made clear that in granting Wheaton College its injunction (as it did earlier this year in a case filed by the Denver-based Little Sisters of the Poor), it was not prejudging the case. “This order should not be viewed as an expression of the Court’s views on the merits,” it said.
But what is less clear is whether people covered by the health plans of those nonprofit organizations that are still in litigation will have access to no-copay contraceptive coverage.
The Supreme Court majority appears to think they can be covered. “Nothing in this interim order affects the ability of the applicant’s employees and students to obtain, without cost, the full range of FDA approved contraceptives,” the order said. “The government contends the applicant’s health issuer and third-party administrator are required by federal law to provide full contraceptive coverage regardless whether the applicant completes EBSA Form 700.”
The Obama administration, however, seems not so sure that will happen. “An injunction pending appeal would deprive hundreds of employees and students and their dependents of coverage for these important services,” the Justice Department wrote in its memorandum to the court.
One thing that is clear: Many more of these cases are yet to be decided by many more courts.
Hobby Lobby ruling spilling over to corporate world
Originally posted July 10, 2014 by Alan Goforth on https://www.benefitspro.com.
Both proponents and opponents of the recent ruling by the U.S. Supreme Court in the Hobby Lobby contraception case agree on at least one thing: The case may be settled, but how it will play out in the workplace is far from certain.
The court ruled that the 1993 Religious Freedom Restoration Act prevents certain employers from being forced to pay for contraceptives they oppose for religious reasons. However, the definition of which types of corporations are excluded remains murky.
"Nobody really knows where it is going to go," said Richard Primus, professor of constitutional law at the University of Michigan. "I assume that many more businesses will seek exemptions, not just from the [Patient Protection and] Affordable Care Act, but from all sorts of things they want to be exempt from, and it will put courts in a difficult position of having to decide what is a compelling government interest."
About 50 lawsuits filed by corporations nationwide, which were put on hold during the Hobby Lobby appeal, must now be resolved or re-evaluated. "We don't know ... how the courts will apply that standard," Primus said.
The decision also has ramifications beyond the courtroom. Even closely held companies with sincere religious beliefs must carefully consider the potential marketplace ramifications of crafting health-care coverage according to religious beliefs.
"Many owners of companies don't want to distinguish the difference between what's good for them personally and what's good for their business," said John Stanton, professor of food marketing at Saint Joseph University in Philadelphia. "I believe that if a business owner believes something is the right thing to do — more power to them. That's his business. However, he's got to be ready for the negative repercussions."
Eden Foods of Clinton, Mich., a natural-foods manufacturer, has filed a lawsuit and is balancing religious beliefs and business concerns. Since Eden initially filed its lawsuit last year over mandates to cover birth control in PPACA, some customers have taken to social media to express disapproval and outrage, even threatening a social boycott. However, the corporation also has gained new customers who support its stance.
"It's very conceivable they could lose business," said Michael Layne, president of Marx Lane, a public relations firm in Farmington Hills, Mich. "And they could lose employees, too."
Experts agree that the myriad issues raised by the Hobby Lobby decision could take a while to play out. "I think there will be a rush of litigation in the next year or two," Primus said. "I think that the exemptions are likely to get broader before they are limited."
Major work needed before enrollment
Originally posted July 10, 2014 by Kathryn Mayer on www.benefitspro.com.
The fall open enrollment period needs some major work, as new analysis out Thursday finds low satisfaction and little results, with many consumers remaining “uninsured and underserved,” after the first shopping experience in the exchanges under the Patient Protection and Affordable Act.
The inaugural J.D. Power 2014 Health Insurance Marketplace Shopper Study, which looked at enrollment satisfaction among more than 1,600 consumers who shopped for coverage under PPACA November 2013 through April 2014, found that satisfaction during the first signup period averaged 615 on a 1,000-point scale.
The results indicate that health plans need to “retool” their efforts ahead of 2015 open enrollment, which begins Nov. 15.
“No doubt that ensuring a technologically error-free experience, along with streamlining the online enrollment process will be most impactful to future marketplace shoppers,” said Rick Johnson, senior director of the health care practice at J.D. Power. “While the uninsured are now a smaller group, they continue to be underserved, just as they were prior to the exchanges, and continue to need more information delivered in an easy-to-understand and personal way.”
J.D. Power found that many shoppers began the enrollment process but had problems completing their plan purchase at the time of the survey primarily due to three reasons:
- A combination of technical problems experienced during the enrollment process (40 percent);
- The application process taking too long (19 percent); and
- The website not having enough information about the plans to make a selection (18 percent).
Additionally, 49 percent of shoppers who didn’t complete enrollment did not choose a plan during their initial shopping experience because they had not yet decided which plan they wanted.
The technical problems for HealthCare.gov have been well-documented.
The survey found that satisfaction was higher among those enrollees who got in-person help from brokers and navigators.
When shoppers used a navigator — a certified agent or broker used by 17 percent of shoppers — during the shopping process, satisfaction rose to a score of 631 compared to 611 for those who didn’t use a navigator.
Though it was the least common way to sign up for a health plan, in-person enrollment had a higher satisfaction rate at 715 points. Online enrollment had a satisfaction score of just 597 while selecting a plan on the phone had a score of 623.
That’s in line with previous research from the Urban Institute and the Robert Wood Johnson Foundation, which found that brokers are the highest-ranked of all information sources on PPACA and enrollment help by consumers.
But that finding also means carriers and brokers have more work to do, too, in working to engage consumers. J.D. Power said that “health insurance companies and the exchanges should continue to find ways to personalize the insurance shopping experience for consumers.”
“When the dust finally settles later in 2014 and in 2015, for health insurance providers to thrive in this new environment, they will need to retool their marketing, information and enrollment efforts toward a new generation of uninsured to serve their needs,” Johnson said.